Case Report (Ola)

8/12/2019 Case Report (Ola)

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Name

Sherla Wijoyo

(C 111 07 095)

Mentors

dr. Teuku Nanta Aulia

dr. Erick Gamaliel Amba

Supervisor

dr. Muhammad Sakti Sp.OT

Orthopedic and Traumatology Department

Hasanuddin University

2012

Closed Fracture of Left Distal Tibia &Closed Fracture Distal Third of Left Fibula


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Patient Identity

NAME : R (boy)

AGE : 7 years old

REGISTRATION : 527616

ADMISSION DATE : January 3th, 2012


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History Taking

Chief Complaint:Pain at the left leg

Suffered since 3 hours before admitted to the Wahidin

Sudirohusodo general hospital due to traffic accident.

Mechanism of Trauma :The patient was playing beside the street and got hit by

motorcycle from his left side.

History of unconsciousness (-), vomiting (-), nausea (-).History of prior treatment at Faisal Hospital.

(At 3thJanuary,


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INSPECTIONDeformity (+), swelling (+), hematoma (+), wound (-).

PALPATIONTenderness (+)

RANGE OF MOVEMENT ROM)Active and passive movement of knee and ankle joints are limited due to pain.

NEUROVASCULAR DISTAL NVD)Sensibility is good, pulse of dorsalis pedis artery is palpable, capillary refill < 2

Secondary Survey(Region: Left Leg)

(At 3thJanuary,


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Secondary Survey(Region: Left Leg)

Side Aspect

Front Aspect

(At 3thJanuary,


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INSPECTIONAbrasion lesion (vulnus excoriation) at medial aspect size 3 x 2 cm,

deformity (-), swelling (-), hematoma (-).

PALPATIONTenderness (+)

RANGE OF MOVEMENT ROM)active and passive movement of ankle joint is limited due to pain.

NEUROVASCULAR DISTAL NVD)Sensibility is good, pulse of dorsalis pedis artery is palpable, capillary refill < 2

Secondary Survey(Region: Left Foot)

(At 3thJanuary,


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Secondary Survey(Region: Left Foot)

Above Aspect

(At 3thJanuary,

Below Aspect Lateral Aspect Medial Aspect


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Leg Length Discrepancy

RIGHT LEFTALL 68 cm 67 cmTLL 65 cm 64 cmLLD 1 cm

(At 3thJanuary,


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Laboratory Findings

WBC 16,82 x 103/uL RBC 4,61 x 106/uL HGB 13,6 g/dL HCT 38,9 % PLT 354 x 103/uL CT 900

BT 300 HbSAg (-)

(At 3thJanuary,


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Radiologic Findings(Right Cruris) (Left Cruris)

AP

view

Lateral

view

Lateral

view

AP

view


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Radiologic Findings(Left Pedis)

AP

view

Oblique

view


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Diagnose

Closed fracture of the Left distal tibia

Closed fracture distal third of the Left fibula

Vulnus excoriation of the Left foot


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Management

IVFD

Antibiotic

Analgesic

Apply long leg back slab

ORIF


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Applied Long Leg Back Slab

Side Aspect

Front Aspect

(At 3thJanuary,


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Left Leg X-Ray

Applied Long Leg Back Slab

AP

view

Lateral

view


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Resume

A boy, 7 years old, came to Wahidin Sudirohusodo Hospital

with chief complaint is pain at the left leg. It suffered since 3

hours before admitted to the hospital due to traffic accident.

On the left leg region: Deformity (+), swelling (+), hematoma

(+), Tenderness (+), active and passive movement of kneeand ankle joints are limited due to pain.Radiographyshowed fracture line in distal of tibia and fibula.

On the left foot region: Abrasion lesion (vulnus excoriation)

at medial aspect size 3 x 2 cm, tenderness (+), active andpassive movement of ankle joint is limited due to pain.

Radiologic findings is within normal limit.


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Discussion


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Tibia & Fibula Shaft Fracture

PEDIATRIC CASE


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Epidemiology

Fractures of tibia shaft are the third most common in children (after

femur and forearm)

Tibia shaft fractures are associated with fibula fractures in 30 percent of

cases.

Of pediatric tibia fractures, 39% occur in the middle third.

Usually due to traffic accident & sports injury

Tibia fracture is commonly in long bone fracture cases.

1. Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures2. TachdjiansPediatric Orthopardics


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Anatomy

Netters concise orthopaedic anato


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Netters concise orthopaedic anatomy, P.316


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Netters concise orthopaedic anatomy, P. 317


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Classification of Fracture

Clinical types:open fracture / close fracture

Etiology :traumatic fracture/ stress fracture/ pathologic fracture

Configuration classification:

Netters concise orthopaedic anatomy,


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Diagnosis

Anamnesis Physical examination

X- ray, with AP and lateral view

Laboratory examination

Oedema Hematoma

Tenderness at the fracture site.

Decreased range of motion at

the ankle or knee, depending

on the location of the fracture

If fracture is displaced, a

deformity may be noted

Appleys. Sistem Of orthopaedis & fracture,8th edition.

Clinical features


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Treatment

Closed reduction followed by a long leg castapplication with ankle slightly plantar flexedand the knee is flexed.

Indication:Closed fracture,

Undisplaced fracture,

Low-energy trauma.

(Conservative)


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Treatment

Open reduction followed by Intramedullary (IM) Nailing, Plateand screw, External fixation.

Indication:

Open fracture.

Fractures in which a stable reduction is unable to be achieved

or maintained.Associated vascular injury.

Fractures associated with compartment syndrome.

Severely comminuted fractures.

Associated femoral fracture (floating knee). Fractures in patients with spasticity syndromes (cerebral

palsy, head injury).

Patients with bleeding diatheses (hemophilia).

Patients with multisystem injuries

Associated plafond fracture

(Operative)


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Complication

Early complications Vascular injury

Nerve injury

Compartment syndrome

Late complications

Infection Delayed union, or non union

Joint stiffness


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Prognosis

For diaphyseal fractures, union can be expected in

over 95 per cent of cases.

Time to healing varies according to patient age:

Neonates: 2 to 3 weeksChildren: 4 to 6 weeks

Adolescents: 8 to 12 weeks


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TH NK YOU


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Differential between bone in child

and adult

1. Fracture more common in child2. Thicker and more active periosteum

3. More rapid fracture healing

4. Special problems of diagnosis

5. Spontaneous correction of certain residualdeformities

6. Differences in complications

7. Different emphasis on methods of treatment

8. Torn ligaments and dislocations less common

9. Less tolerance of major blood loss

10. Still has epiphysial plate


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The muscles in the anterior and the lateral compartments of the lower

leg produce a valgus deformity in complete ipsilateral tibia and fibula

fractures.


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CAS

T

KIRSCHNER

WIRE

IM

NAILING

EXTERNAL

FIXTATION

PLATE &SCREWS


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Conservative Method

Application of a long leg cast with progressive weight

bearing can be used for closed, low-energy fractures withminimal displacement and comminution

Cast with the knee in 0 to 5 degrees of flexion to allow forweight bearing with crutches as soon as tolerated by

patient, with advancement to full weight bearing by thesecond to fourth week.

After 4 to 6 weeks, the long leg cast may be exchanged fora patella-bearing cast or fracture brace.

Union rates as high as 97% are reported, although withdelayed weight bearing related to delayed union or

nonunion.


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Documents

Case Report (Ola)